A novel soft tissue graft alternative in rhinoplasty: the buccal fat graft

Background Camouflage grafts are prepared from alar, auricular cartilages, deep-temporal, rectus, mastoid fascia, fat-dermofat tissue, and allografts. Rhinoplasty and bichectomy may be combined. This study aimed to introduce buccal fat as a graft alternative in rhinoplasty. Methods Patients who had rhinoplasty with utilization of buccal fat between January 2017 and March 2021 were included in study. Bichectomies were performed after bone/cartilage reconstruction of rhinoplasty and 3–5 cc buccal fat was extracted 0.5–1 cm cranial to Stenon orifice. Buccal fats were placed in serum filled 20 cc injector, and injector was placed in a sterile ice cubes. Before utilization, buccal fats were immersed in a serum-antibiotic solution. Buccal fat was sutured over dome for cartilage camouflage in majority of patients. For treatment of the glabellar depression (2 male pts, 25 and 32 years age), the suture was self-knotted, and fat was passed through suture till the knot. Then, the suture was passed through nasal dorsum, pierced out glabella, and fat was settled. For scar restoration (1 female pt, 34 years age), buccal fat was sutured beneath depressed scar over ala. Polydiaxonone 6/0 round suture was used for fixations. Results Forty-eight patients were operated with this technique. Thirty-six patients were female; twelve were male. The mean age was 26 years (18–41 years). In 45 patients, rhinoplasty-bichectomy was combined, and the buccal fat was used as a camouflage graft. In 3 patients, the buccal fat was used for pseudohump (2patients) and scar (1patient) restoration. Cartilage visibility was absent in all patients. Pseudohump restoration was satisfactory without fat absorption. Scar restoration was satisfactory. Conclusions In rhinoplasties combined with bichectomy, buccal fat pad may be utilized as a soft-tissue graft source. It also may be used as a soft-tissue graft in selected rhinoplasties without a planned bichectomy. Level of evidence: Level IV, therapeutic study